Ask Dr. Schulman...

[Dr. Schulman 2]

I will add a question as well Dr Schulman

I have had one consult with a re constructive surgeon and he suggested an abdominoplasty. I have a huge scar from a left hepact..... (whatever the word is for removal of the left lobe of my liver) due to an adenoma. I had a PE following surgery - 2 years ago. This surgeon is concerned about my past PE however he said he could still do the surgery on me however it would be a very conservative procedure due to my significant scarring and the PE. He hasn't operated on a person who has had a PE before so I am wondering if I should see someone who has had more experience in operating on people who have had clots? I assume all surgeons have to start somewhere though.

PEs are rare, so I would not bother trying to find a PS who has operated on someone with a PE - they may be hard to find.

You should consult with a hematologist and you may consider having a filter placed at the time of surgery. You should also be given blood thinners prior to and after surgery. These are all reasons for your surgeon to be extra carefull.

[nursenky9 0]

Dr. Schulman:

Thanks for your response. I toured your website. Very nice work!!

Thanks for all you do for the obese community.

[Dr. Schulman 2]

Dr. Schulman:

Thanks for your response. I toured your website. Very nice work!!

Thanks for all you do for the obese community.

Thank you for the kind words. Out of all my different types of patients, I find the weight loss patients the most motivated and helping them is extremely rewarding.

Please excuse the plugs......

1. I will be on "The New You" radio show Wed. Aug 6th. You can listen online live and there is a live interactive chat room and live callers. It would be great to have everyone's support and also I will be able to answer your questions live. For those of you who have listened to this show before, it is very entertaining and very interactive.
   
2. I also hope to see all you east coast bandsters at the Walk From Obesity event in NYC, Sept., 28th. Stop by my table so I can meet you. I will have lots of goodies and pictures. I hope to see all of you there for this very worthwhile event!
   
3. I have also gotten some pms asking me to re-post the link to my last radio appearance on the "Health and Beauty Revolution." Thank you to everyone for the great feedback about that appearance. Here is the link.
   

[Fanny Adams 7]

The scar from the gyn surgery is not an issue at all. In fact, the majority of my patients have a pre-existing scar in that area (s-secction, etc.). This is removed with the PS - eith an panni, abdominoplasty, or LBL. The Scar from the kidney surgery is a little more of an issue. Because of blood supply issues, it may interfere a bit with PS - it may limit the amount of tissue removed in that area, but this really depends on exactly where the scar is (your PS will evaluate it when the time comes). Either way, this kidney scar can be revised - it can be redone by your PS and made to look nicer.

Hope this helps. Good luck with the weight loss

Thank you Dr Schulman, I appreciate you taking the time to answer.

[BeckyinTexas 3]

Dr. Schulman...Just in case you ever forget this, you have and still are making such a positive difference in people's lives. I sincerely thank you for your time and knowledge that you so generously share with us. If it weren't for your suggestion, I wouldn't have my appointment with UT Southwestern Monday. I'm just hoping and praying it will work out as well as I think it will. Thank you again for being what we call here in Texas....just a plain ole good guy!

[KD8888 0]

Dr. Schulman,

Thank you for the info on how much training a PS has vs. eye doctor. I was definitely not comfortable with upper eyelid surgery from an eye doctor.

The rest of the story is that it is for my husband who has difficutly hearing (not the selective kind of problem). He may not have communicated our intension to have the surgery by my plastic surgeon. My husband has not had the consult with the PS yet. I just knew that he needed certain testing before insurance would approve. My PS's office does participate with our insurance, so he can submit the results once we have them. For some odd reason, the eye doctor's office didn't do the testing while he was there, they scheduled another appointment.

Thanks again.

[Frangipani 1]

Hi Dr. Schulman,

I'm scheduled to have a buttocks/outer thigh lift and liposuction next month and my Dr. is proposing to do the autologous fat/tissue transfer in the buttocks that you discussed in page one of this thread.

If you don't mind sharing, I was wondering how satisfied your patients are generally with this procedure. Also, do you have any other photos that you could share? Since this seems to be a relatively new procedure (I think?), I'm having a hard time finding many photos on the web.

[Boo Boo Kitty 3]

Dr Schulman

I am having a revision on my TT and breast reduction from May. I am very unhappy and the Dr has told me that it will "all be on him" as far as cost for the revision. Is it appropriate to tell him while he is fixing the breasts that I want small implants to fill them out? How do I ask?

Thanks!

[Dr. Schulman 2]

Dr Schulman

I am having a revision on my TT and breast reduction from May. I am very unhappy and the Dr has told me that it will "all be on him" as far as cost for the revision. Is it appropriate to tell him while he is fixing the breasts that I want small implants to fill them out? How do I ask?

Thanks!

I am just curious about the "all be on him" statement - usually, when PS need to perform revisions, they will forgive the surgoens fee, but usually the patient is responsible for the anesthesia and facility fee. You may want to double check this with your PS. It would be unusual for your doctor to pay the anesthesia and facility fee as well as not charge for the surgeons fee.

About the implants, just ask him "if the revision that he is doing will result in upper pole fullness, or will you do better with a small implant at the same time". See what he says. I suspect he will tell you that an implant may be necessary, but yuo should wait until everything is healed and the breasts take the final shape in ablout a year - at that point an implant can be added if you are still unhappy. It becomes a complicated procedure because it is a revision of something done fairly recently.

[nume130 0]

I need a breast lift, something done with my arms and a lower body lift and inner thigh lift. What is usually the order of surgeries, what can be combined?

[Dr. Schulman 2]

I need a breast lift, something done with my arms and a lower body lift and inner thigh lift. What is usually the order of surgeries, what can be combined?

You can do this in any order. I ask my patients what bothers them most, and the answer will determine the order.

A LBL is the largest of the procedures and usually requires the most recovery. This tends to be a good place to start, because it usually "jumps starts" your weight loss again. It also gives the most dramatic improvement. You can then proceed with the arms and breasts which do very well combined. Also, if your surgeon is very experienced, and you are healthy and motivated, you may be able to do the inner thighs at the same time as well.

Again, the order is determined by you - what bothers you most, the amount of recovery you will need, and financial considerations.

[Dr. Schulman 2]

Hi Dr. Schulman,

I'm scheduled to have a buttocks/outer thigh lift and liposuction next month and my Dr. is proposing to do the autologous fat/tissue transfer in the buttocks that you discussed in page one of this thread.

If you don't mind sharing, I was wondering how satisfied your patients are generally with this procedure. Also, do you have any other photos that you could share? Since this seems to be a relatively new procedure (I think?), I'm having a hard time finding many photos on the web.

I perform autologous augmentation of the buttocks. The key is that the tissue is never separated from its blood supply. It is not fat injections, but rather a fat "flap." My patients have been happy. It gives a longstanding result - unlike fat injections which lose around 50% of volume after the first several months. Also, my patients do not need to avoid sitting for 2 weeks as is the case after fat injections. I think you are correct that this is not that common, but it is increasing in number. I will try to get you some other photos of this procedure.

[Frangipani 1]

Thanks Dr. S!

You're always so wonderful with the prompt and thorough responses.

The procedure you describe sounds like the very same procedure that my Dr. is proposing to do (i.e., using flaps that are not completely disconnected from the blood supply, but merely rotated and placed)

I'm so glad to hear that I (probably) won't need to stay off my backside, for two weeks either. I have a list of questions that I'm putting together to discuss with my Dr., and that was definitely one of them.

If you are able to post any other photos, that would be great.

Thanks again,

:thumbup::smile::wub:

[targa 0]

Hi Dr Schulman-

I am wondering if the rate at which you lose weight has any impact on the loose skin problem. I have about 85-90lbs to lose...if it is lost at about 10-12 lbs per month will my skin look the same as if it is lost faster?

Thanks so much!

Targa

[Dr. Schulman 2]

Hi Dr Schulman-

I am wondering if the rate at which you lose weight has any impact on the loose skin problem. I have about 85-90lbs to lose...if it is lost at about 10-12 lbs per month will my skin look the same as if it is lost faster?

Thanks so much!

Targa

There are 4 factors that impact skin laxity after weight loss:

1. amount of weight you lose - greater than 100 pounds is considered "massive weight loss"
   
2. rate at which you lose it - under 1 year is considered "rapid"
   
3. age - younger skin is more resiliant to weight loss and can "shrink" better
   
4. genetics - this is the mystery factor and has a lot to do with it.
   

So in general, weight loss of 85-90 pounds over the course of 1 year in a young individual will likely lead to good "shrinking" of your skin. But, as many on this board will tell you, you just never know.....you will jsut have to see how you respond. Keep your nutrition level good during the weight loss period.